Patient's Guide - Vasectomy Reversal by Microsurgery

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Vasovasostomy Technique

The Key to Successful Vasectomy Reversal

Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal by vasovasostomy (VV). The first condition is rather obvious. The patient must have sperm available to pass through at least one reconnection. The second condition is that each reconnection must be as watertight as possible. The surgeon's goal is to achieve a very precise reconnection of the sperm canal edges. Many microsurgical sutures (size 10-0) with meticulous placement greatly enhance this goal.

FULL THICKNESS SUTURE TECHNIQUE

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This illustrates just one Full Thickness (FT) suture. Using 12-14 of these sutures is routine and each simultaneously reconnects both the sperm canal mucosal edges and the vas muscle surfaces.

Twelve to fourteen FT, very tiny (size 10-0) sutures are precisely placed for each reconnection of a normal size vas. Compare this approximation of the edges of the vas canal to the four sutures with the modified one-layer VV, or the 6 to 8 sutures of the two-layer VV. VV's that leak sperm generally fail due to scarring.

The first seven FT sutures are seen here from the inside with ZOOM magnification after the vas has been rolled half-way around. The backside is now in front and ready for the second 7 FT sutures.

OTHER MICROSURGICAL TECHNIQUES

Two Layer

#1 An inner mucosal
layer suture

#2 A superficial
layer suture

Modified One Layer

#1 This is the first of four
     quadrant FT   sutures
     at 12,3,6, and 9 o'clock.

#2  A superficial suture placed
      between the four FT sutures

The above two-layer technique has only 6-8 sutures approximating the mucosal edges of the vas canal (inner circle). The modified one-layer technique has only four sutures approximating the vas canal edges. Superficial outer sutures only provide additional strength to the reconnection of the vas ends. They do very little to improve the critical water-tightness.

OBSOLETE NON-MICROSURGICAL TECHNIQUE

After placing the first two 6-0 sutures there is barely room for four more.

This magnified illustration demonstrates the crude reconnection by non-microsurgical techniques. The use of excessively large (size 6-0) sutures cannot be avoided by naked eye or loupe magnification techniques. Sperm leakage is almost routine and subsequent excessive scarring with obstruction is very common.

Vasovasostomy Technique

The Key to Successful Vasectomy Reversal

This illustrates just one Full Thickness (FT) suture. Using 12-14 of these sutures is routine and each simultaneously reconnects both the sperm canal mucosal edges and the vas muscle surfaces.

The first seven FT sutures are seen here from the inside with ZOOM magnification after the vas has been rolled half-way around. The backside is now in front and ready for the second 7 FT sutures.

#1 An inner mucosal layer suture#2 A superficial layer suture

#1 This is the first of four quadrant FT sutures at 12,3,6, and 9 o'clock.#2 A superficial suture placed between the four FT sutures

After placing the first two 6-0 sutures there is barely room for four more.

#1 An inner mucosal
layer suture

#2 A superficial
layer suture

#1 This is the first of four
quadrant FT sutures
at 12,3,6, and 9 o'clock.

#2 A superficial suture placed
between the four FT sutures